title: How to avoid iatrogenic morbidity and mortality while increasing availability of oxytocin and misoprostol for PPH prevention?
abstract: OBJECTIVE
  Increased availability of oxytocin and misoprostol is needed to reduce the risk of postpartum hemorrhage. This review compiles rates and risks of adverse maternal and perinatal outcomes associated with use of these medications for labor induction and augmentation in low-income countries. Recommendations are proposed based on the findings.
  
  
  METHODS
  We did a structured literature review using 5 databases followed by analysis of induction and augmentation rates from existing data.
  
  
  RESULTS
  Combined induction and augmentation rates were documented in up to 50% of hospital-based deliveries identified in the databases. Data are sparse but suggest associations between induction/augmentation and stillbirth, neonatal resuscitation, and uterine rupture, and inappropriate administration of oxytocin and misoprostol both outside and inside healthcare systems in low-income countries.
  
  
  CONCLUSIONS
  Guidelines for labor induction/augmentation are needed specifically for low resourced settings. Rigorous studies should be pursued to quantify the magnitude and effect of inappropriate induction and augmentation on maternal and perinatal morbidity and mortality. Programs are needed to ensure community-wide awareness of the adverse effects of the improper use of these drugs on mothers and babies, especially in out-of-hospital settings.
authors.affiliation: Owen Sound, Ontario, Canada. alovold@jhsph.edu
authors.forename: Ann
authors.initials: A
authors.lastname: Lovold
authors.forename: Cynthia
authors.initials: C
authors.lastname: Stanton
authors.forename: Deborah
authors.initials: D
authors.lastname: Armbruster
mesh_terms: D003906:Developing Countries; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000401:mortality*; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects*; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011256:Pregnancy Outcome / Q000453:epidemiology; D012306:Risk
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D010121:Oxytocin